MEDICARE: JOANNA KOWALEWSKI DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	046206	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336285311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNA KOWALEWSKI DDS PC

Provider Business Mailing Address
First Line	:	120 NASSAU AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-4024
Country	:	US
Telephone Number	:	718-389-8889
Fax Number	:	718-389-7502

Provider Business Practice Location Address
First Line	:	120 NASSAU AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-4024
Country	:	US
Telephone Number	:	718-389-8889
Fax Number	:	718-389-7502

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOANNA KOWALEWSKI
Credential	:
Telephone Number	:	718-389-8889

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	09/20/2007

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